Diagnosis
The first important step in diagnostics is the conversation between doctor and patient. Here the doctor can ask whether the patient has noticed a prolonged bleeding period, e.g. in the case of a small skin incision or increased bruising. Current medications, especially blood-thinning drugs such as heparin, ASS or Marcumar and a possible familial bleeding tendency can also identify possible causes.
This is followed by a physical examination in which, for example, an enlarged spleen can be palpated, but signs of the above-mentioned underlying diseases can also be found. Finally, a laboratory examination of the blood is essential. Here, for example, the shape and quantity of the thrombocytes are assessed under a microscope.
This can also provide indications of cancer. The cause of thrombocytopenia is determined by the so-called “mean platelet volume”, which can be used to determine whether there is a production or degradation disorder by the size of the blood platelets. If the laboratory shows thrombocytopenia, which, however, does not cause any symptoms and was discovered rather by chance, a so-called “pseudothrombocytopenia” should always be excluded. In this case, the laboratory result is falsified, for example due to long transport times of the blood sample.
Symptoms
The thrombocytes cause hemostasis. Therefore, if there is a deficiency, there is an increased and prolonged bleeding tendency. This is first noticed by small things: a small incision bleeds significantly longer, light bumps cause bruises and there is frequent nose or gum bleeding.
If the thrombocyte count exceeds 30,000 cells per μl, some patients do not experience any symptoms at all. If the thrombocyte count continues to decrease, so-called petechiae occur, minimal bleeding into the skin, which can be recognized as small reddish-violet spots. In addition, there are enlarged bruises and spontaneous bleeding on mucous membranes.
If the cause is one of the above-mentioned underlying diseases, specific accompanying symptoms may occur. For example, cancers often cause fever, night sweats and unwanted weight loss. Rheumatoid arthritis manifests itself in additional joint complaints.
If the bone marrow is damaged, however, the production of further blood cells is often also damaged and this can lead to anemia, anemia, which is often associated with fatigue, tiredness and paleness.Since thrombocytopenia has a serious cause, symptoms should always be clarified by a visit to a doctor. If the cause is one of the above-mentioned underlying diseases, specific accompanying symptoms may occur. For example, cancers often cause fever, night sweats and unwanted weight loss.
Rheumatoid arthritis manifests itself in additional joint complaints. If the bone marrow is damaged, however, the production of further blood cells is often also damaged and this can lead to anemia, anemia, which is often associated with fatigue, tiredness and paleness. Since thrombocytopenia has a serious cause, any symptoms should always be clarified by a visit to a doctor.
In special situations, thrombocytopenia can occur simultaneously with thrombosis. For example, in the case of a consumption coagulopathy, a drop in the number of thrombocytes is a first diagnostic indication. While in the acute stage of DIC, considerable microthrombus formation with vascular occlusion, necrosis and organ infarction may occur initially, bleeding due to the consumption of coagulation factors is often characteristic of the advanced stage.
Relative heparin-associated thrombocytopenia may also increase the risk of thrombosis. In this case thrombocytopenia occurs after heparin administration. The prognostically favorable type HIT1, which is based on a direct interaction between heparin and thrombocytes, must be distinguished from a more severe type HIT2.
In this case, thrombocyte aggregation occurs as a result of antibody formation against the specific complex of the surface protein platelet factor 4 of the thrombocytes and heparin. Even if a reduction in the absolute platelet count is observed here, platelet aggregation can lead to thrombembolic events. The basic therapeutic rule in the event of HIT2 is to immediately discontinue the existing administration of heparin and to change the therapy to Argatroban or recombinant hirudin.
An external administration of platelet concentrates is absolutely contraindicated! In the case of a deficiency in the formation of blood cells, symptoms of increased fatigue or a drop in performance and lack of concentration can occur. In the case of an isolated thrombocyte deficiency, however, symptoms of fatigue are not usually to be expected.
Nevertheless, in the special form of pernicious anemia, a drop in the concentration of all blood cell rows can be observed. It is caused by a lack of vitamin B12 (extrinsic factor). Due to the primarily reduced erythrocyte count and the associated megaloblastic (hyperchrome/macrocytic) anemia, fatigue can occur.
